A treatise on orthopedic surgery . PEDIC SUBGEBT. to the thickening of the synovial membrane and capsule, whichgives the sensation of elastic resistance rather than of actualfluctuation. Limitation of Motion.—The most important diagnostic sign islimitation of the range of motion caused by muscular normal range is from complete extension (180 degrees)to a degree of flexion, limited by contact of the calf and thethigh. Even in the early stage of disease slight limitation ofcomplete extension is present, due to reflex muscular spasm, andusually a corresponding limitation of the complete
A treatise on orthopedic surgery . PEDIC SUBGEBT. to the thickening of the synovial membrane and capsule, whichgives the sensation of elastic resistance rather than of actualfluctuation. Limitation of Motion.—The most important diagnostic sign islimitation of the range of motion caused by muscular normal range is from complete extension (180 degrees)to a degree of flexion, limited by contact of the calf and thethigh. Even in the early stage of disease slight limitation ofcomplete extension is present, due to reflex muscular spasm, andusually a corresponding limitation of the complete flexion. Onsudden movements the characteristic reflex contraction of themuscles is apparent. In most cases this limitation of motionand consequent flexion deformity is well-marked on the firstexamination. Atrophy of the muscles of the thigh and calf,dependent upon the duration of the disease and upon the inter-ference with function, is present, and this atrophy is morenoticeable because of the enlargement of the knee. Fig. After forcible correction, showing the increase of the posterior displacementDrawing from the x-vaj photographs of an actual case in which the limb hadbeen corrected by direct force in the ordinary manner. See reverse 295. In certain cases, more often seen in infancy and early child-hood, the symptoms are more acute and the progress of thedisease is so rapid that it may simulate an infectious epiphysitis(Fig. 289). In another type, apparently a primary disease of the synovialmembrane, more common in • adults, the early symptoms arevery similar to those of simple chronic synovitis. The joint isswollen by a distention of the capsule, pain is not troublesomeexcept on jars or sudden twists of the limb, and muscular spasmand limitation of motion are evident only after a careful ex-amination. In this class, months or years may pass before the TUBERCULOUS DISEASE OF THE KNEE-JOINT. 423 symptoms become as disabling as in the osteal type of th
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